BILL NUMBER: SB 648	CHAPTERED  09/29/00

	CHAPTER   835
	FILED WITH SECRETARY OF STATE   SEPTEMBER 29, 2000
	APPROVED BY GOVERNOR   SEPTEMBER 28, 2000
	PASSED THE SENATE   AUGUST 31, 2000
	PASSED THE ASSEMBLY   AUGUST 30, 2000
	AMENDED IN ASSEMBLY   AUGUST 29, 2000
	AMENDED IN ASSEMBLY   AUGUST 25, 2000
	AMENDED IN ASSEMBLY   JULY 6, 2000
	AMENDED IN ASSEMBLY   JUNE 21, 2000
	AMENDED IN ASSEMBLY   MAY 15, 2000

INTRODUCED BY   Senator Ortiz

                        FEBRUARY 24, 1999

   An act to amend Sections 2242 and 3502.1 of the Business and
Professions Code, and to amend Section 120500 of, and to add Section
120582 to, the Health and Safety Code, relating to public health.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 648, Ortiz.  Venereal disease:  chlamydia:  treatment of
partner.
   Existing law requires the State Department of Health Services to
investigate conditions affecting the prevention and control of
venereal diseases, as defined, and approved procedures for prevention
and control, and to disseminate educational information relating to
venereal disease.
   This bill would revise the definition of venereal disease to
include chlamydia.  It would authorize a physician and surgeon who
diagnoses a sexually transmitted chlamydia infection in an individual
patient to prescribe, dispense, furnish, or otherwise provide
prescription antibiotic drugs to that patient's male sexual partner
or partners without examination of that patient's partner or
partners, and would authorize the department to adopt regulations to
implement this provision.  The bill would also authorize certain
other qualified health professionals to dispense, furnish, or
otherwise provide prescription antibiotic drugs to the partner or
partners of a patient with a diagnosed sexually transmitted chlamydia
infection without examination of the patient's sexual partner or
partners.
   The Medical Practice Act provides that the prescribing,
dispensing, or furnishing of dangerous drugs, as defined, without a
good faith prior examination and medical indication therefor
constitutes unprofessional conduct.  Existing law sets forth
exceptions to this provision.
   This bill would provide that a licensee acting in accordance with
provisions of the bill with regard to a prescription for antibiotic
drugs has not committed unprofessional conduct under this provision.

   Existing law specifies the circumstances under which a physician
assistant is authorized to administer or provide medication to a
patient or transmit orally, or in writing, an order to a person who
may lawfully furnish the medication or medical device.
   This bill would add to these circumstances the activities of a
physician assistant with regard to a prescription for antibiotic
drugs in accordance with the provisions of this bill.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  (a) The Legislature finds and declares the following:
   (1) One out of 10 couples in California has problems with
fertility.
   (2) Pelvic inflammatory disease (PID) is the leading preventable
cause of tubal infertility.
   (3) Recurrent genital chlamydial infections due to nontreatment of
sexual partners of persons with these genital infections greatly
contributes to the development of PID.
   (4) Current rates of chlamydial infection among Californians
warrant enhanced and expanded disease prevention and control efforts.

   (5) Partner-delivered treatment is a recognized component of these
control efforts.
   (b) It is the intent of the Legislature that physicians and
surgeons be allowed to ensure adequate medical treatment and
management of sexual partners of persons diagnosed with chlamydia and
for programs to support the medical evaluation and treatment of
partners.
  SEC. 2.  Section 2242 of the Business and Professions Code is
amended to read:
   2242.  (a) Prescribing, dispensing, or furnishing dangerous drugs
as defined in Section 4022 without a good faith prior examination and
medical indication therefor, constitutes unprofessional conduct.
   (b) No licensee shall be found to have committed unprofessional
conduct within the meaning of this section if, at the time the drugs
were prescribed, dispensed, or furnished, any of the following
applies:
   (1) The licensee was a designated physician and surgeon or
podiatrist serving in the absence of the patient's physician and
surgeon or podiatrist, as the case may be,  and if the drugs were
prescribed, dispensed, or furnished only as necessary to maintain the
patient until the return of his or her practitioner, but in any case
no longer than 72 hours.
   (2) The licensee transmitted the order for  the drugs to a
registered nurse or to a licensed vocational nurse in an inpatient
facility, and if both of the following conditions exist:
   (A) The practitioner had consulted with  the registered nurse or
licensed vocational nurse who had reviewed the patient's records.
   (B) The practitioner was designated as the practitioner to serve
in the absence of the patient's physician and surgeon or podiatrist,
as the case may be.
   (3) The licensee was a designated practitioner serving in the
absence of the patient's physician and surgeon or podiatrist, as the
case may be, and was in possession of or had utilized the patient's
records and ordered the renewal of a medically indicated prescription
for an amount not exceeding the original prescription in strength or
amount or for more than one refilling.
   (4) The licensee was acting in accordance with Section 120582 of
the Health and Safety Code.
  SEC. 3.  Section 3502.1 of the Business and Professions Code is
amended to read:
   3502.1.  (a) In addition to the services authorized in the
regulations adopted by the board, and except as prohibited by Section
3502, while under the supervision of a licensed physician and
surgeon or physicians and surgeons approved by the board, a physician
assistant may administer or provide medication to a patient, or
transmit orally, or in writing on a patient's record or in a drug
order, an order to a person who may lawfully furnish the medication
or medical device pursuant to subdivisions (c) and (d).  A physician
assistant also may dispense, furnish, or otherwise provide
prescription antibiotic drugs in accordance with Section 120582 of
the Health and Safety Code and subdivisions (c) and (d).
   (1) A supervising physician and surgeon who delegates authority to
issue a drug order to a physician assistant may limit this authority
by specifying the manner in which the physician assistant may issue
delegated prescriptions.
   (2) Each supervising physician and surgeon who delegates the
authority to issue a drug order to a physician assistant shall first
prepare and adopt a written, practice specific, formulary and
protocols that specify all criteria for the use of a particular drug
or device, and any contraindications for the selection.  The drugs
listed shall constitute the formulary and shall include only drugs
that are appropriate for use in the type of practice engaged in by
the supervising physician and surgeon.  When issuing a drug order,
the physician assistant is acting on behalf of and as an agent for a
supervising physician and surgeon.
   (b) "Drug order" for purposes of this section means an order for
medication that is dispensed to or for a patient, issued and signed
by a physician assistant acting as an individual practitioner within
the meaning of Section 1306.02 of Title 21 of the Code of Federal
Regulations.  Notwithstanding any other provision of law, all of the
following shall apply:
   (1) A drug order issued pursuant to this section shall be treated
in the same manner as a prescription or order of the supervising
physician.
   (2) All references to "prescription" in this code and the Health
and Safety Code shall include drug orders issued by physician
assistants pursuant to authority granted by their supervising
physicians.
   (3) The signature of a physician assistant on a drug order shall
be deemed to be the signature of a prescriber for purposes of this
code and the Health and Safety Code.
   (c) A drug order for any patient cared for by the physician
assistant that is issued by the physician assistant shall either be
based on the protocols described in subdivision (a) or shall be
approved by the supervising physician before it is filled or carried
out.
   (1) A physician assistant shall not administer or provide a drug
or issue a drug order for a drug other than for a drug listed in the
formulary without advance approval from a supervising physician and
surgeon for the particular patient.  At the direction and under the
supervision of a physician and surgeon, a physician assistant may
hand to a patient of the supervising physician and surgeon a properly
labeled prescription drug prepackaged by a physician and surgeon,
manufacturer as defined in the Pharmacy Law, or a pharmacist.
   (2) A physician assistant may not administer, provide or issue a
drug order for Schedule II through Schedule V controlled substances
without advance approval by a supervising physician and surgeon for
the particular patient.
   (3) Any drug order issued by a physician assistant shall be
subject to a reasonable quantitative limitation consistent with
customary medical practice in the supervising physician and surgeon's
practice.
   (d) A written drug order issued pursuant to subdivision (a),
except a written drug order in a patient's medical record in a health
facility or medical practice, shall contain the printed name,
address, and phone number of the supervising physician and surgeon,
the printed or stamped name and license number of the physician
assistant, and the signature of the physician assistant.  Further, a
written drug order for a controlled substance, except a written drug
order in a patient's medical record in a health facility or a medical
practice, shall include the federal controlled substances
registration number of the physician assistant.  The requirements of
this subdivision may be met through stamping or otherwise imprinting
on the supervising physician and surgeon's prescription blank to show
the name, license number, and if applicable, the federal controlled
substances number of the physician assistant, and shall be signed by
the physician assistant.  When using a drug order, the physician
assistant is acting on behalf of and as the agent of a supervising
physician and surgeon.
   (e) The medical record of any patient cared for by a physician
assistant for whom the supervising physician and surgeon's drug order
has been issued or carried out shall be reviewed and countersigned
and dated by a supervising physician and surgeon within seven days.
   (f) All physician assistants who are authorized by their
supervising physicians to issue drug orders for controlled substances
shall register with the United States Drug Enforcement
Administration (DEA).
  SEC. 4.  Section 120500 of the Health and Safety Code is amended to
read:
   120500.  As used in the Communicable Disease Prevention and
Control Act (Section 27) "venereal diseases" means syphilis,
gonorrhea, chancroid, lymphopathia venereum, granuloma inguinale, and
chlamydia.
  SEC. 5.  Section 120582 is added to the Health and Safety Code, to
read:
   120582.  (a) Notwithstanding any other provision of law, a
physician and surgeon who diagnoses a sexually transmitted chlamydia
infection in an individual patient may prescribe, dispense, furnish,
or otherwise provide prescription antibiotic drugs to that patient's
sexual partner or partners without examination of that patient's
partner or partners.  The department may adopt regulations to
implement this section.
   (b) Notwithstanding any other provision of law, a nurse
practitioner pursuant to Section 2836.1 of the Business and
Professions Code, a certified nurse-midwife pursuant to Section
2746.51 of the Business and Professions Code, and a physician
assistant pursuant to Section 3502.1 of the Business and Professions
Code may dispense, furnish, or otherwise provide prescription
antibiotic drugs to the sexual partner or partners of a patient with
a diagnosed sexually transmitted chlamydia infection without
examination of the patient's sexual partner or partners.
